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2900-0858, Supporting Statement (VAF21-4142, 4142a)
2900-0858, Supporting Statement (VAF21-4142, 4142a).docx
Authorization and Consent to Release Information to VA (VA Form 21-4142), General Release for Medical Provider Information to VA (VA Form 21-4142a)
OMB: 2900-0858
OMB.report
VA
OMB 2900-0858
ICR 202404-2900-008
2900-0858, Supporting Statement (VAF21-4142, 4142a)
( Supporting Statement A )
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